Barriers and facilitators to adherence to “test and treat” of malaria case management guidelines by health providers in Lilongwe District, Malawi in 2020

Abstract

Background: Malaria is one of the major causes of morbidity and mortality in sub-Saharan African. In 2010, the World Health Organization (WHO) recommended malaria testing and treatment for all suspected malaria cases. Since 2013, Malawi has been implementing the malaria test and treatment guidelines. In 2018, Malawi reported a high prevalence of malaria (24%). The malaria program report shows that 45% of malaria suspects were presumptively treated in 2019 at Bwaila Hospital, in Lilongwe District. Overuse and inappropriate prescription of anti-malarial drugs is a major problem. The study explored barriers and facilitators to adherence to test and treatment of malaria case management guidelines in Lilongwe District.Methods: This was a qualitative study. In-depth interviews using a semi-structured interview guide was used to explore the experience of twelve health providers of malaria test and treatment guidelines. The interviews were audio-recorded, transcribed and analysed using the framework approach. Data collected were categorized as adherence and non-adherence based on respondent responses on practices in managing patients with fever. Adherence was defined as the prescription of antimalarial drugs to parasitological confirmed malaria cases.Findings: Respondents were two clinical officers, four medical assistants, two registered nurses and four Health Surveillance Assistants (HSAs). The barriers to adherence to malaria test and treatment were; critical health condition of the patient, patient’s satisfaction, patient volume, limited diagnostic tools and provider perception of low detection of malaria cases by Rapid Diagnostic Tests (RDT). Facilitators to adherence were the implementation of Community Integrated Management of Child Illnesses (C-IMCI), disbursement of Artemether Lumefantrine (AL), antibiotics guidelines and RDT positive results. Despite comprehensive knowledge of malaria test and treatment, health providers still prescribed anti-malarial drugs to patients with negative results. Health providers considered patient condition as the most critical factor in the management of fever.Conclusion: To improve adherence to malaria test and treatment, health providers should be provided with enough resources at the health facility. Health providers should build trust in RDT negative results by strengthening their skills in IMCI to improve RDT compliance, rational drug use and quality fever care. National Malaria Control Programme (NMCP) should conduct regular supervisions and provide feedback to health providers to improve the quality of clinical services delivered to avoid the development of drug resistance to first-line anti-malarial drugs, antibiotics and adverse health effects to patients.